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Syphilis

NOTICE: This health information was not created by the University of Michigan Health System (UMHS) and may not necessarily reflect specific UMHS practices. For medical advice relating to your personal condition, please consult your doctor. Complete disclaimer

Syphilis

Topic Overview

What is syphilis?

Syphilis is a
sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. If it's not
treated by a doctor, it can get worse over time and cause serious health
problems.

The infection can be active at times and not active at
other times. When the infection is active, you have symptoms. When it's not
active, you don't have symptoms, even though you still have syphilis. But even
when you don't have symptoms, you can pass syphilis to others.

You don't
have to have sexual intercourse to get syphilis. Just being in close contact
with an infected person's genitals, mouth, or rectum is enough to expose you to
the infection.

What causes syphilis?

Bacteria cause syphilis.
They usually enter the body through the tissues that line the throat, nose,
rectum, and vagina. A person with syphilis who has a sore or a rash can pass
the infection to others. An infected pregnant woman can also pass syphilis to her
baby.

Some things increase your chance of getting syphilis. They
include:

Having unprotected sex (such as not using
condoms or not using them correctly). This risk is high among men who have
sex with other men.

Having more than one sex partner and
living in an area where syphilis is common.

What are the symptoms?

You may not notice symptoms
of syphilis. Sometimes they are the same as symptoms for other infections. This
can cause someone with the infection to put off seeing a doctor. And it can make
it harder for a doctor to tell if you have syphilis.

The four
stages of syphilis have different symptoms.

Primary stage: One of
the first signs is a painless open sore called a chancre (say "SHANK-er").
Because syphilis is usually spread when people have sexual contact, chancres
are often found in the mouth, the anus, or the genital area. They may also be
found wherever the bacteria entered the body.

Secondary stage: A skin rash and other symptoms may show up 2
to 12 weeks after a person is infected. At this stage, it is very easy to
spread the infection through contact with the mouth, the anus, the genitals, or
any area where there is a skin rash.

Latent stage: After the rash clears, a person may have a period with no
symptoms. This is often called the "hidden stage." Even though symptoms go
away, the bacteria that cause syphilis are still in the body and begin to
damage the internal organs. This stage may be as short as 1 year or last from 5
to 20 years. Often, a woman with latent-stage syphilis doesn't find out that
she has the infection until she gives birth to a child with
syphilis.

Late (tertiary) stage: If syphilis
is not found and treated in the early stages, it can cause other serious health
problems. These can include blindness, problems with the
nervous system and the heart, and mental disorders. It
can also cause death.

How is syphilis diagnosed?

If you have sores,
bumps, a rash, blisters, or warts on or around your genital or anal area, or if
you think you were exposed to an STI, see your doctor.

He or she
will do a physical exam and will ask you about your symptoms and your sexual
history. You will probably have one or more blood tests to check for the
infection. Because the open sores from syphilis make HIV infection more likely,
you may also be tested for HIV.

To prevent babies from getting
syphilis, experts recommend that all pregnant women have a syphilis blood
test.

How is it treated?

Syphilis can be cured with
antibiotics. Both you and any sex partners that you
may have exposed to the infection will need to be treated.

It is
important to know that syphilis is not a infection that you can treat on your
own. It must be treated with medicine that only your doctor can give you. With
treatment, you avoid other serious health problems. And treatment keeps you from spreading
syphilis to others.

If a woman is pregnant and has untreated
syphilis, it can cause miscarriage or stillbirth. It can also cause the baby to
be born with the infection. This is called congenital syphilis.

At
any stage of the infection, antibiotics work well to cure syphilis. They can't
undo the damage already caused by late-stage syphilis. But they can help you
avoid further problems from the infection.

How can you prevent syphilis?

There are some
things you can do to lower your risk for getting syphilis. Whether you have never had the infection or if you have had it before and are trying to keep from getting it again, it is important to practice safer sex. Safer sex includes using
condoms and using them correctly.

Sores mainly occur on the external genitals, vagina,
anus, or rectum. Sores can also occur on the lips and in or around the mouth.
The bacteria most commonly enter the body through mucous membranes, usually in
the area around the genitals and urinary system.

In rare cases,
syphilis enters the body through openings in the skin, such as cuts and
scrapes, or even through wet kisses, if the infected person has a sore on the
mouth or lips. Syphilis may also be transmitted by using a needle previously
used by an infected person. Syphilis can be transmitted through a
blood transfusion. But this is very rare, because all
donated blood in the United States and Canada is screened for some
sexually transmitted infections (STIs). And syphilis
bacteria cannot survive more than 24 to 48 hours in blood stored using modern
blood-banking methods.

A pregnant woman with syphilis can pass the
infection through the
placenta and infect her baby any time during pregnancy
or delivery (congenital syphilis).

Having
been infected with syphilis in the past does not protect a person from
becoming infected again.

Incubation period

An incubation period is the time
between exposure to a disease and the first symptom. A skin
sore called a chancre is usually the first symptom of sexually transmitted syphilis. A
chancre appears between 3 weeks to 3 months after a person has been
infected with syphilis.

Contagious period

A person with syphilis can
easily pass the infection (is contagious) to physically intimate partners when
primary- or secondary-stage sores are present. But the person may be contagious for years, off and on, and is always contagious whenever an
open sore or skin rash from syphilis is present.

Symptoms

Syphilis
develops in four stages, each with a different set of symptoms.

Primary stage

During the primary stage of
syphilis, a sore (chancre) that is usually painless develops at the site
where the bacteria entered the body. This commonly occurs within 3 weeks of
exposure but can range from 10 to 90 days. A person is highly contagious during
the primary stage.

In men, a chancre often appears in the
genital area, usually (but not always) on the penis. These sores are often
painless.

In women, chancres can develop on the outer genitals or
on the inner part of the vagina. A chancre may go unnoticed if it occurs inside
the vagina or at the opening to the uterus (cervix). The sores are
usually painless and are not easily seen.

A chancre may also occur in an area of the body other than
the genitals.

The chancre usually lasts for 3 to 6 weeks, heals without treatment,
and may leave a thin scar. But even though the chancre has healed, syphilis is still present and a person can still pass the infection to others.

Secondary stage

Secondary syphilis is
characterized by a rash that appears 2 to 12 weeks after the chancre
develops and sometimes before it heals. Other symptoms may also occur,
which means that the infection has spread throughout the body. A person is
highly contagious during the secondary stage.

A rash often
develops over the body and commonly includes the palms of the hands and the
soles of the feet.

The rash usually consists of reddish brown,
small, solid, flat or raised skin sores that are less than
2 cm (0.8 in.) across. But the
rash may look like other more common skin problems.

Small, open
sores may be present on
mucous membranes. The sores may contain pus. Or moist
sores that look like warts (called condyloma lata) may be present.

In dark-skinned people, the sores may be a lighter color than the
surrounding skin.

The skin rash usually heals within 2 months on its
own without scarring. After healing, skin discoloration may occur. But even though the skin rash has healed, syphilis is still present and a person can still pass the infection to others.

Nervous system symptoms of
secondary syphilis, which can include neck stiffness, headaches, irritability,
paralysis, unequal reflexes, and irregular pupils.

Latent (hidden) stage

If untreated, an infected
person will progress to the latent (hidden) stage of syphilis. The latent stage
is defined as the year after a person becomes infected. After the
secondary-stage rash goes away, the person will not have any symptoms for a
time (latent period). The latent period may be as brief as 1 year or range from
5 to 20 years.

Often during this stage, an accurate diagnosis can
only be made through blood testing, the person's history, or the birth of a
child with
congenital syphilis.

A person is
contagious during the early part of the latent stage and may be contagious
during the latent period when no symptoms are present.

Relapses

About 20 to 30 out of 100 people with syphilis
have a
relapse of the infection during its latent
stage.1 A relapse means the person was
symptom-free but then started having symptoms again. Relapses can occur
several times.

When relapses no longer occur, a person is not
contagious through contact. But a woman in the latent stage of syphilis may
still pass the infection to her developing baby and may have a miscarriage or a
stillbirth or give birth to a baby infected with congenital syphilis.

Tertiary (late) stage

This is the most destructive
stage of syphilis. If untreated, the tertiary stage may begin as early as 1
year after infection or at any time during a person's lifetime. A person with
syphilis may never experience this stage of the illness.

During
this stage, syphilis may cause serious blood vessel and heart problems, mental
disorders, blindness, nerve system problems, and even death. The symptoms of
tertiary (late) syphilis depend on the complications that develop.
Complications of this stage include:

Congenital syphilis

Congenital syphilis
refers to syphilis passed from a mother to her baby during pregnancy or during
labor and delivery. The U.S. Centers for Disease Control and Prevention (CDC)
and the
U.S. Preventive Services Task Force strongly recommend
that all pregnant women be screened for syphilis because of the severe
consequences of being pregnant while infected or having a child born with
congenital syphilis. Screening should be done:2, 3

At the first prenatal visit for all pregnant
women.

At the beginning of the third trimester of pregnancy and
again at delivery for women who are at high risk for syphilis.

Congenital syphilis increases the risk of fetal death and
medical complications in newborns. Syphilis enters the fetal blood system
through the
placenta, causing infection in the newborn or death of
the fetus. Symptoms of congenital syphilis include:

A highly contagious watery discharge from the
nose.

Painful inflammation.

Contagious rash that frequently appears over the palms of
the hands and soles of the feet.

Because there are
other conditions with similar symptoms, an accurate
diagnosis is important for treatment.

What Happens

About 3 weeks—although the
range is from 10 to 90 days—after a person is infected with
syphilis, a sore (chancre) that is
usually painless often appears on the genitals. This first stage in the course
of syphilis is referred to as the primary stage. The
chancre usually heals without treatment in 3 to 6 weeks.

If
syphilis is not treated during the primary stage, it often progresses to later
stages.

In the secondary stage of syphilis,
a skin rash will usually develop about 2 to 12 weeks after the chancre appears. The
symptoms usually disappear without treatment within 2 months.

After the rash clears, a person may have a period with no symptoms. This
symptom-free period is called the latent (hidden) stage.
Even though symptoms disappear, the bacteria that cause syphilis remain in the
body and begin to damage the internal organs. The latent period may be as brief
as 1 year or range from 5 to 20 years.

A person is contagious
during the primary and secondary stages and may still be contagious during the
early part of the latent stage. During this time, symptoms of
the second stage of syphilis may reappear. This is called a
relapse and can occur several times.

If
not detected and treated, syphilis may then progress to the tertiary (late) stage, the most destructive stage of syphilis.
During this stage, syphilis may cause serious blood vessel and heart problems,
mental disorders, blindness, nerve system problems, and even death. It may
begin as early as 1 year after infection or at any time during the infected
person's life. About one-third of untreated people who are infected
with syphilis will have the complications of tertiary (late) syphilis. Any
organ system (such as the
central nervous system) may become involved.

Congenital syphilis refers to syphilis passed from the
mother to the baby during pregnancy or during labor and delivery. Congenital syphilis can cause complications in
newborns and children.

What Increases Your Risk

Your risk of
syphilis increases if you:

Have unprotected sex (do not use condoms or do
not use them correctly). This risk is especially high among men who have sex with other men (MSM).

Have
multiple sex partners, particularly if you live in an area of the country where
syphilis is more common.

Have a sex partner who has
syphilis.

Have sex with a partner who has multiple sex
partners.

Exchange sex for drugs or money.

Have human immunodeficiency virus (HIV) infection
and engage in any of the behaviors listed above.

Syphilis is contagious whenever an open sore or skin rash
is present. The risk of being infected with syphilis from a single sexual
encounter with an infected partner is approximately 3% to 10%.4

Infection with syphilis also increases a
person's risk of being infected with HIV. Syphilis causes open sores on the
genitals that allow the HIV infection to enter the body easily. Syphilis is
in general more common in people who are also infected with HIV.

When To Call a Doctor

Call to make an appointment if
you:

Have sores, bumps, rashes, blisters, or warts
on or around the genital or anal area or on any area of the body where you
think they could be caused by a
sexually transmitted infection (STI).

Think
you have been exposed to a STI.

Note:

In most areas, public health clinics or health
departments are able to diagnose and provide low-cost assessment and treatment
of early syphilis and other sexually transmitted infections (STIs).

Watchful waiting

Watchful waiting, which means taking a
wait-and-see approach, is not appropriate if you think you were exposed to or
have
syphilis or another sexually transmitted infection
(STI). Any symptoms or other changes that suggest syphilis or another STI should be evaluated by a doctor. If you
suspect a syphilis infection:

Make an appointment with your doctor. Early treatment can reduce the complications of syphilis and
prevent the spread of the infection to others.

Do not have sexual
intercourse or other sexual contact until you have been treated by a doctor.

If you are diagnosed with syphilis, your sex partner(s)
will need to be treated also.

All states require doctors to report newly diagnosed cases of syphilis (all stages) to
health authorities.

A careful examination of the skin and mouth to look for any rash or other abnormalities.

For women, a
pelvic exam to look for signs of syphilis.
During the pelvic exam, your doctor will look for abnormal sores
in the vagina or on the vulva, labia, rectal area, and inner thighs. These
sores occur during the primary stage of syphilis.

For newborns, an examination of both the newborn and the mother for symptoms. The evaluation for congenital
syphilis begins with a review of the mother's health and testing the mother for
syphilis.

The diagnosis of syphilis
is usually confirmed with one of several
blood tests. This is especially true if no sores are
present. If sores are present, a doctor may look at the fluid from
one of the sores with a microscope to see whether syphilis bacteria are present
(dark-field examination).

The diagnosis of syphilis can be delayed or complicated
because its symptoms are very similar to those of many
other diseases and are sometimes not recognized.
Syphilis has historically been called "the great imitator."

Early detection

Screening for syphilis is strongly recommended
for pregnant women and for people who are at increased risk for the
infection.

People at high risk of contracting syphilis include those
who:

Have unprotected sex (do not use condoms or
do not use them correctly). This risk is especially high among men who have sex
with men (MSM).5

Have multiple sex partners, particularly if they live in
an area of the country where syphilis is more common.

Have a sex
partner who has syphilis.

Have sex with a partner who has multiple
sex partners.

Exchange money or drugs for sex
(prostitution).

Have human immunodeficiency virus (HIV) infection.

The U.S. Centers for Disease Control and Prevention (CDC) and the
U.S. Preventive Services Task Force strongly recommend
that pregnant women be screened for syphilis because of the severe consequences
of being pregnant while infected or having a child born with
congenital syphilis. Screening should be done:2, 3

At the first prenatal visit for all pregnant
women.

During the third trimester and again at delivery for
pregnant women who have an increased risk for syphilis.

Treatment Overview

Prompt treatment of
syphilis is needed to cure the infection, prevent
complications, and prevent the spread of the infection to others.

Antibiotics
effectively treat syphilis during
any stage.

Antibiotic treatment cannot reverse the damage caused
by complications of late-stage syphilis, but it can prevent further
complications.

Follow-up blood tests are done
to make sure that treatment has been effective.

Sex partners of a person who has syphilis need to be
examined, tested, and treated for syphilis. Antibiotic treatment is recommended for all exposed sex partners.

Penicillin is the preferred drug for treating
syphilis. Penicillin is the standard therapy
for the treatment of
neurosyphilis,
congenital syphilis, or syphilis acquired or detected
during pregnancy. If you are allergic to penicillin, make sure you tell
your doctor. Your doctor will still be able to treat the syphilis but may
consult with a specialist on the best antibiotic choice.

Prevention

Self-care can lower your risk for an
initial infection of or reinfection with
syphilis or other
sexually transmitted infections (STIs).

Use a condom during sex. Using a condom is the
best way to protect yourself from STIs.

Medications

The treatment of
syphilis and other
sexually transmitted infections (STIs) is complex. If
taken properly,
antibiotic treatment with penicillin will usually cure
a syphilis infection. If syphilis has progressed to the
tertiary stage, antibiotics can prevent further
complications. But they cannot reverse damage that has already occurred. Prompt
antibiotic treatment will decrease complications and prevent the spread of the
infection.

Exposed sex partners should be treated
for syphilis. The chancres in
syphilis can make transmission of HIV more likely. So
testing for both syphilis and
HIV should be done.

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